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46
Maternity
The maternity units have had a most difficult year, as is evident from the
following figures:—
(1) Ihe number 01 confinements in 1946 (21,385) rose to the 19.59 level,
but the number of available beds, even at the end of the year, was 168 less than
in 1939, i.e. 886 against 1,054.
(2) The over-pressure on the units was even worse than these figures
indicate, for the rate of admission rose sharply in the second half of the year
and was not evenly distributed throughout the year. Moreover, the number
of beds available was much reduced for substantial periods by closure on account
of infection among patients or illness or shortage of staff.
(3) The main problem in all units has been shortage of staff. There have
been grave deficiences in all grades of midwives and domestic workers.
(4) Irregular movements of the population made the resumption of early
and continuous ante-natal care almost impossible and the proportion of emergency
admissions had grown from the pre-war figure of under 10 per cent, to
20 per cent, and even 40 per cent, in some areas.
(5) To cover the shortage of accommodation, a complicated system of bed
allocations has to be worked. Normal cases are required to have their babies
at home with a domiciliary midwife in attendance, or, if the home conditions
are impossible, to be evacuated three to four weeks before the confinement to
a provincial maternity establishment conducted by a local authority at the
instigation of the Ministry of Health. Hospital beds in London are reserved
as far as possible for abnormal cases, women living under bad home conditions
who cannot be found a bed under the evacuation scheme, and acute emergencies.
Unfortunately it is impossible in practice to make clear-cut divisions into these
categories, and considerable inconvenience is caused to all concerned, especially
to mothers who find that they are still left in uncertainty about their plans
within a few weeks of their confinement. But for the helpful co-operation
of the officers of the London boroughs and of the London Voluntary Hospitals
Joint Committee, the situation would have been far worse.
In the circumstances, it is not surprising that the maternal death-rate for 1946
is not as satisfactory as in past years. Experience has shown that a minimum
maternal death-rate can only be achieved by adequate staffs working in adequately
equipped maternity units and that the system of ante-natal care must be simple,
smooth-running and complete for every emergency. The high incidence of deaths
from causes which are included in the theoretically "preventible" category (e.g.
eclampsia 7, and sepsis 5) shows that London is still paying the penalty of war
disorganisation. Most of the women who died from eclampsia were admitted
moribund or almost so. One of the patients with sepsis and two with placenta
praevia were admitted in a hopeless condition. A woman died from anaphylaxis
after an injection of sucrose, and two women died (probably, though not certainly)
from results of blood transfusion administered for an obstetrical emergency. The
Rhesus factor is now estimated in every case attending the Council's ante-natal
clinics and very valuable work has been done in the saving of infant lives.